FAQs on ACOs

Most hospital administrators are probably up to their ears in conversations about the proposed rules for ACOs released March 31. We provided the previous two links in case you need a little refresher or have questions. The Patient Protection and Affordable Care Act of 2010 requires the HHS Secretary to establish an ACO program that will measure quality and total cost of care for assigned beneficiaries, beginning in calendar year 2012. ACOs would share in savings with the Medicare program if quality and cost objectives are met. The ACO program is voluntary and requires a three-year agreement from participating providers. ACOs are eligible to receive a shared savings payment if their actual spending is below a pre-determined applicable benchmark.

CMS proposes that an ACO choose one of two risk models: the "one-sided" risk model allows an ACO to pursue fee-for-service Medicare payment with shared savings for the first two years, and then requires the ACO to assume risk for shared losses in the third year; while the "two-sided" risk model requires ACOs to share savings and losses for all three years. ACOs would also be required to meet certain quality benchmarks. For year one, CMS proposes 65 measures spanning five quality domains: patient experience of care, care coordination, patient safety, preventive health and at-risk populations. AHA members today will receive a Special Bulletin summarizing key aspects of the rule. The rule was published in the April 7 Federal Register and comments will be accepted through June 6.

05-04-2011 10:06 (EDT)